Background/Purpose: Migraine is the second most prevalent neurologic disorder and is known to be associated with neurogenic inflammation. Previous studies suggest an association between migraine and chronic inflammatory rheumatic diseases. However, the relationship between rheumatoid arthritis (RA) and migraine has yet to be determined. This study aimed to evaluate the association between RA and subsequent migraine risk specifically in the Korean population.

Methods: This was a retrospective cohort study using the Korean National Health Insurance Service database. Participants were enrolled from 2010 to 2017 and followed up until 2019 (median follow up 4.4 years after a 1-year lag period). RA was defined using ICD-10 codes, prescription of any disease modifying anti-rheumatic drug, and enrollment in the Rare and Intractable Disease program. A total of 42,674 patients who had undergone a health checkup within 2 years prior to the initial diagnosis of RA were included in the study, after applying the exclusion criteria (previous migraine, other rheumatic disease, missing variables that were of interest). Among them, there were 29,744 patients with seropositive RA (SPRA) and 12,900 patients with seronegative RA (SNRA). A non-RA control was obtained by age- and sex- matching (1:5), resulting in the inclusion of 213,370 non-RA participants as controls. Primary outcome was the occurrence of incident migraine, defined using the ICD-10 code of migraine (G43) in the claim database. Cox proportional hazards regression analyses and Kaplan Meier curve were used for analysis.

Results: A total of 22,294 migraine cases (17,912 control and 4,382 RA) had developed. RA participants had a 1.2-fold higher risk of migraine compared with controls (adjusted hazard ratio [aHR] 1.2, 95% confidence interval [CI] 1.17-1.26). Increased risk of migraine was found in both patients with SNRA and SPRA compared with controls (aHR 1.20, CI 1.15-1.24 in SPRA; aHR 1.26, CI 1.20-1.33 in SNRA). Compared to the SNRA group, those with SPRA did not demonstrate a heightened risk (aHR 0.94, CI 0.88-1.01). The association between RA and incident migraine was statistically significant in males (aHR 1.3 in male, 1.2 in female, p for interaction 0.04), current smokers (aHR 1.35 in current smoker, 1.31 in ex-smoker, 1.2 in never smoker, p for interaction 0.02), those with diabetes mellitus (aHR 1.33 in DM, 1.2 in non-DM, p for interaction 0.04,) and those with hyperlipidemia (aHR 1.31 in hyperlipidemia, 1.17 in non-hyperlipidemia, P for interaction 0.002).

Conclusion: RA was associated with increased risk of migraine. There was no difference in the risk of developing migraine based on seropositivity for rheumatoid arthritis.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/rheumatoid-arthritis-and-risk-of-migraine-a-population-based-nationally-representative-cohort/